Preliminary Efficacy of a Web-Based Alcohol and Emotion Regulation Intervention on Intimate Partner Aggression Among College Women

Objective

Intimate partner aggression (IPA), encompassing psychological and physical aggression, is a public health concern due to its high rates among young adults. Research and theory connect heavy drinking and emotion regulation (ER) difficulties to IPA and highlight their potential role in reducing IPA. A web-based intervention combining alcohol reduction strategies with ER skills demonstrated initial efficacy at reducing heavy drinking and improving ER abilities among college women with sexual assault victimization histories.

Method

The present study represents a secondary analysis of this brief web-based intervention to evaluate its preliminary efficacy on IPA. The sample comprised 200 heavy drinking college women with histories of sexual assault victimization randomized to an assessment only control or the intervention consisting of 14 brief online alcohol reduction and ER skill building modules administered daily over a two-week period. The analytic sample included 103 women who reported their psychological and physical IPA at both the 1- and 6-month follow-up surveys.

Results

After controlling for alcohol use, repeated measures mixed models examining changes from baseline to 6-month follow-up by condition revealed a significant time-by-intervention interaction effect on psychological IPA. Women who received the intervention had a significant decrease in psychological IPA from baseline to 6-month follow-up; there was no change in psychological IPA among women in the control condition. There was no significant effect of the intervention on physical IPA.

Conclusion

Reducing alcohol use and improving ER skills may be beneficial in helping women cope with relational conflict, thereby decreasing their use of psychological IPA.

Emotion Regulation and Intimate Partner Violence Perpetration in Undergraduate Samples: A Review of the Literature

Intimate partner violence (IPV) perpetration increases throughout young adulthood and is particularly widespread among college students, resulting in mental health and academic consequences. Deficits in emotion regulation (ER) are an important factor associated with IPV perpetration; the developmental tasks and challenges associated with college, including relationship stressors and hazardous alcohol use, implicate ER as a particularly relevant risk factor for IPV perpetration. Thus, college presents an important opportunity for intervention in order to change the trajectories of IPV perpetration across young adulthood. The purpose of this review was to synthesize findings regarding ER and psychological, physical, and sexual IPV perpetration among college students. Twenty-one articles met inclusion criteria. Studies were organized into five categories: (a) direct associations of ER with IPV perpetration, (b) qualitative assessment of ER and IPV, (c) ER in indirect effects models, (d) ER in moderation models, and (e) experiments with ER instructional sets. Overall, ER emerged as an important inhibiting factor for IPV perpetration, particularly impulse control and access to ER strategies. ER deficits in the context of impelling (e.g., negative affect, trauma history) and instigating (e.g., provocation) factors emerged as consistent predictors of psychological and physical IPV perpetration for both male and female students. Deficits in ER were associated with sexual IPV perpetration among men; however, very few studies examined sexual IPV. Experimental paradigms suggest cognitive reappraisal may reduce IPV perpetration, while suppression may, in some contexts, increase perpetration. Methodological strengths and weaknesses and implications for IPV prevention and interventions programming for college students are discussed.

Initial efficacy of a web-based alcohol and emotion regulation intervention for college women with sexual assault histories

OBJECTIVE

College women with sexual assault histories report greater heavy drinking relative to those without histories of assault. Moreover, individuals with sexual assault histories often have difficulty regulating emotions and tolerating distress, which can lead to a problematic pattern of drinking to cope. Thus, we evaluated the initial efficacy of a web-based alcohol intervention that included strategies to reduce drinking and improve regulatory skills for heavy drinking college women with sexual assault histories.

METHOD

The sample comprised college women (N = 200) who were 20.9 (SD = 2.8) years old and primarily White (69%). They were randomized to an assessment-only control or intervention and completed 14 daily diary assessments, pre- and posttreatment surveys, and 1- and 6-month follow-up surveys. During daily diary, the intervention group received a brief (5-10 min) alcohol reduction or regulatory skill module each day.

RESULTS

Reductions in drinking quantity and heavy episodic drinking were found for the intervention group at posttreatment and 1-month follow-up relative to controls. Improved regulatory skills and reduced posttraumatic stress disorder (PTSD) symptoms were reported at posttreatment for women who received the intervention compared to controls. Although gains were maintained, the intervention group no longer differed from controls by 6-month follow-up.

CONCLUSIONS

Results suggest this web-based intervention may result in short-term reductions in drinking and PTSD symptoms as well as improvements in regulatory abilities for college women with sexual assault histories. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A formative evaluation of a web-based intervention for women with a sexual assault history and heavy alcohol use

OBJECTIVE

Sexual assault (SA) among college women is widespread and is associated with negative consequences including heavy drinking. However, women with SA histories are rarely the target of alcohol interventions, and existing alcohol interventions do not address the distal factors that contribute to heavy drinking in this group, such as emotion regulation and distress tolerance. The goal of this study was to evaluate a newly developed web-based alcohol intervention targeting college women with SA histories.

METHOD

Heavy-drinking college women with SA histories (N = 21) reviewed a series of brief web-based alcohol reduction and regulatory (i.e., emotion regulation, distress tolerance) skill modules and provided feedback on each module.

RESULTS

Directed content analysis of open-ended survey responses resulted in three themes: intervention content (i.e., what was said in the intervention), intervention delivery (i.e., the look and feel of the intervention), and areas for improvement (i.e., how to enhance the intervention). Quantitative ratings indicated that participants found skill modules moderately relevant and engaging, and qualitative themes and subthemes highlighted important areas for improvement.

CONCLUSIONS

Incorporating user feedback early in the intervention development process provides critical information for content and delivery modifications that may enhance the target population's engagement and satisfaction with the final product. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological Effects of Abuse, Partner Pressure, and Alcohol: The Roles of in-the-Moment Condom Negotiation Efficacy and Condom-Decision Abdication on Women's Intentions to Engage in Condomless Sex

Women's experiences of intimate partner violence (IPV) from their male partners can include psychological, physical, and sexual control and abuse. The psychological effects of abuse (PEA) include terror, shame, and loss of power and control in relationships. While women's experiences of IPV are associated with decreased condom use, limited research has examined the impact of PEA on women's condom use. Intoxicated (breath alcohol content [BrAC] = .10%) versus sober women were evaluated to test the hypothesis that PEA would interact with intoxication and scenario-context partner pressure to forgo condom use and be associated with intentions to engage in condomless sex. After beverage administration, community women (N = 405) projected themselves into a computerized scenario depicting a male partner exerting high or low pressure for condomless sex. In-the-moment condom negotiation self-efficacy and condom-decision abdication-letting the man decide on condom use-were assessed. Path analysis examined the direct and indirect effects of PEA, alcohol, and partner pressure conditions on condomless sex intentions. PEA increased condomless sex intentions indirectly through decreased condom negotiation self-efficacy. Intoxication increased condomless sex intentions indirectly through decreased condom negotiation self-efficacy and increased condom-decision abdication. Intoxicated women in the low pressure condition were more likely to abdicate the condom decision than women in the high pressure condition. Women who have experienced greater PEA may benefit from interventions focusing on how condom negotiation self-efficacy, condom-decision abdication, and intoxication influence sexual decision-making.

Predicting rape events: The influence of intimate partner violence history, condom use resistance, and heavy drinking

Sexual aggression perpetration is a public health epidemic, and burgeoning research aims to delineate risk factors for individuals who perpetrate completed rape. The current study investigated physical and psychological intimate partner violence (IPV) history, coercive condom use resistance (CUR), and heavy episodic drinking (HED) as prospective risk factors for rape perpetration. Young adult men (N = 430) ages 21-30 completed background measures as well as follow-up assessments regarding rape events perpetrated over the course of 3 months. Negative binomial regression with log link function was utilized to examine whether these risk factors interacted to prospectively predict completed rape. There was a significant interaction between physical IPV and HED predicting completed rape; men with high HED and greater physical IPV histories perpetrated more completed rapes during follow-up than men with low HED at the same level of physical IPV. Moreover, psychological IPV and coercive CUR interacted to predict completed rape such that men with high coercive CUR and greater psychological IPV histories perpetrated more completed rapes throughout the follow-up period than men with low coercive CUR at the same level of psychological IPV. Findings suggest targets for intervention efforts and highlight the need to understand the topography of different forms of aggression perpetration.

A Prospective Examination of Men's Condom Use Resistance: Event-Level Associations with Sexual Aggression, Alcohol Consumption, and Trait Anger

Burgeoning research suggests that men engage in a variety of coercive and non-coercive tactics to avoid condom use (condom use resistance; CUR), suggesting a risk nexus regarding sexual risk and sexual aggression (SA). Laboratory-based research has found that acute alcohol intoxication is associated with CUR; however, no study has examined event-level associations among alcohol consumption, SA history, and CUR or the moderating effects of trait anger. Non-problem drinking young adult men who have sex with women (N = 430) completed a background survey and follow-up assessments regarding their sex events and alcohol consumption over three months. CUR was reported in 113 sex events; 6.2% of these involved SA and 40.7% involved alcohol consumption. Generalized estimating equations demonstrated that men with more severe SA histories were more likely to perpetrate CUR. Men lower in trait anger were more likely to perpetrate CUR the more they increased above their typical level of alcohol consumption, whereas men higher in trait anger were similarly likely to perpetrate CUR regardless of their alcohol consumption. Results suggest that men with greater SA histories and high trait anger are at increased risk of perpetrating CUR, and that risk of CUR increases among other men the more they increase their alcohol consumption beyond their average.

Sexual Victimization and Sex-Related Drinking Motives: How Protective is Emotion Regulation?

One in five college women experience sexual victimization (SV), and SV severity is associated with subsequent psychological distress, including sex-related distress. SV severity may also be associated with drinking motives to cope with sex-related distress and to enhance sex (sex-related drinking motives [SRDMs]), particularly if individuals suffer from emotion regulation (ER) difficulties. College women (N = 151) completed a survey assessment of ER, SV history, childhood sexual abuse (CSA), and SRDMs. Twelve regression models assessed six facets of ER as moderators between SV severity and SRDMs. Among women with no or low levels of prior SV severity, women with greater access to ER strategies were less likely to endorse drinking to cope SRDMs. At higher levels of SV severity, women at all levels of access to ER strategies were equally likely to endorse drinking to cope SRDMs, suggesting that access to ER strategies did not mitigate motivations to drink to cope with sex-related distress for these women. Women with severe SV histories may benefit from interventions that build on existing ER strengths or address other factors. However, greater access to ER strategies may serve as a protective factor against SRDMs when SV severity is low.

Men's Coercive Condom Use Resistance: The Roles of Sexual Aggression History, Alcohol Intoxication, and Partner Condom Negotiation

Condom use resistance (CUR) through coercive tactics is a significant public health concern. The present study investigated CUR risk factors through an alcohol administration experiment using a sexual risk analog with a community sample of male nonproblem drinkers ( N = 321). Utilizing a path analysis framework, results demonstrated that men with more severe sexual aggression histories displayed stronger in-the-moment power and control responses, which was associated with greater coercive CUR and unprotected sex intentions. A significant interaction between sexual aggression history, risk rationale, and alcohol condition also predicted coercive CUR intentions. These findings emphasize the relationship between sexual aggression and sexual risk behaviors and highlight the importance of targeting these constructs in intervention and prevention efforts.

Daily Associations Between Alcohol Consumption and Dating Violence Perpetration Among Men and Women: Effects of Self-Regulation

OBJECTIVE

Alcohol intoxication has been associated with dating violence perpetration, defined here as psychological and/or physical violence occurring between young adult dating partners. However, little is known about how the individual variability in the level of alcohol intoxication would influence dating violence perpetration and how sex and self-regulation might influence this association.

METHOD

College-aged men and women (N = 146) from a large southwestern U.S. university completed background questionnaires, including the Brief Self-Control Scale, to assess self-regulation and then reported their dating violence perpetration and alcohol consumption using a 90-day Timeline Followback assessment. Their average estimated blood alcohol concentration (eBAC) and their daily deviation from this average were calculated for each of the 90 days to examine the between- and within-person effects of alcohol consumption, respectively.

RESULTS

Results of a two-level generalized estimating equation suggest that increases in daily eBAC were associated with an increased likelihood of perpetrating dating violence; however, this association was stronger for those who had a low average eBAC compared with those who had a high average eBAC. For those who had a low average eBAC, higher self-regulation was associated with a lower probability of perpetrating dating violence, whereas among those with a high average eBAC, self-regulation was not associated with dating violence perpetration. Sex did not moderate the association between eBAC and dating violence perpetration.

CONCLUSIONS

Findings highlight the importance of self-regulation in dating violence perpetration-particularly for those with low average eBACs-and the need for varied intervention strategies, depending on one's typical drinking pattern.

Emotion Regulation Difficulties Moderate the Association Between Heavy Episodic Drinking and Dating Violence Perpetration Among College Men

Because of high rates of heavy drinking and dating violence (psychological or physical aggression toward a dating partner) among college men, we examined whether emotion regulation difficulties moderated the association between heavy drinking and dating violence perpetration. One hundred and fifty-eight men were recruited from a large northwestern US university between April 2014 and August 2014. Participants completed an online survey that assessed their emotion regulation difficulties as well as their past year history of heavy episodic drinking (HED; consuming 5+ drinks in 2 hours) and dating violence perpetration. Generalized linear models revealed that the positive association between HED and dating violence perpetration was stronger for men with greater impulse control difficulties and for those who reported limited access to emotion regulation strategies. In addition to continued efforts to reduce heavy drinking among college men, interventions targeting emotion regulation difficulties should be incorporated into standard dating violence intervention and prevention efforts to further reduce the likelihood of dating violence perpetration in this population.

Serum sodium stabilizing effect of enalapril after standard water load in a patient with a history of self-induced water intoxication

1. A 21 day prospective placebo controlled double blind cross over trial of enalapril was studied in a normonatremic patient with a known history of SIWI. 2. At the end of each prophylactic treatment, the patient was challenged with a water load of 20 ml/kg. 3. The mean serum sodium of 140.111 mmol/L on prophylactic enalapril was significantly higher than the 137.6 mmol/L on placebo (p = 0.0015). 4. After a water load, the mean serum sodium on enalapril was 137.6 mmol/L, compared to 133.833 mmol/L (p = 0.0015) on placebo.